Presentations - European Midwives Association
Transcription
Presentations - European Midwives Association
General Meeting 2014 Tallinn Welcome! Opening address and welcome Mervi Jokinen President European Midwives Association Minutes of meeting Zagreb GM 2013 Mervi Jokinen President European Midwives Association Official opening of the General Meeting 2014 Pille Teesalu President Estonian Midwives Association " EMA AGM 2014 TALLINN, ESTONIA ACHIVEMENTS SINCE 2007 2007 1. Midwife as the profession was recognized 2. Midwifery in Estonia was and still is changing rapidly 3. Lack of Legislation Midwifery care 2014 • Midwife is recognized as the member of primary health care system (2008, Primary Health Care Masterplan) • Since 1-st of april 2010 independent midwifery care was legalised (incl. right to prescribe) • 2014.01.08. Regulation of homebirth is included in to legislation Education • • • • • • • • 2 Health Care Colleges in Tartu and in Tallinn Competence based Midwifery programs since 2009 Institutional accreditation in 2013 Direct entry Nominal length of studies 4,5 years, 270 EAP National student places 25-30 Diploma of professional higher education Midwifery master's level Organisation 2014 • Since 2012 transition to the 8-level progressive system of vocational qualifications • 2014 EMA nominated as the main assessor of qualifications • Post-graduation courses - systematic since 2012 • ICM (Durban – 10, Praque – 17) • EMA – AGM annually (1-2), 2013 – Maastricht (3) • Elections 2014 (new president, vice- president, board, council) WELCOME! Official opening of the General Meeting 2014 Urmas Kruuse Minister of Social Affairs, Estonia " Annual Report 2013-2014 Mervi Jokinen President European Midwives Association Annual Report 2013-2014 -Financial Report 2013-2014 -Financial Committee verbal report -Approval of the Financial Report -Financial Committee 2014-2015 Annual Report 2013-2014 -CPD project - EAHC -ICM -Strengthening midwifery associations -Partnerships EMA Strategy 2013-2015 Pictures from last year Coffee break Midwifery in Estonia EAHC/2013/Health/07 • Study concerning the review and mapping of continuous professional development and lifelong learning for health professionals in the EU Council of European Dentists (CED) Standing Committee of European Doctors (CPME) European Federation of Nurses Associations (EFN) European Midwives Association (EMA) European Public Health Alliance (EPHA) Pharmaceutical Group of the European Union (PGEU) OBJECTIVES OF THE STUDY Provide an accurate, comprehensive and comparative account of CPD models, approaches and practices for health professionals and how these are structured and financed in the EU-28 and the EFTA/EEA countries Facilitate a discussion between organisations representing health professionals and policy-makers, regulatory and professional bodies to share information and practices on the CPD of health professionals and to reflect on the benefits of European cooperation in this area for the good of patients of Europe Duration: October 2013 to October 2014 STUDY METHODOLOGY Literature review on CPD in Europe Survey Structure of questionnaire: Structures & Governance/ Development & Implementation / Accreditation / Financing & Transparency / Content / Trends & Reflections Research on European-level initiatives on CPD Technical workshop Final report ISSUES TO DEFINE Mandatory vs. voluntary CPD: predefined requirement by a competent authority Formal vs. informal: is CPD recordable and verifiable? Conceptual context: continuous professional development, continuing education, life-long learning SURVEY complex survey for many national associations if national organisation tried to contact competent authority survey monkey missing answers verification on the country profile level constant changes and challenges ?political influence •During this meeting I expect to discuss any questions •Clarification required some countries •Political fallout Annual Report 2013-2014 Discussion on the annual report and strategic plan Evaluation of 4th EMA Educational conference Maastricht 2013 Franka Cadee Koninklijke Nederlandse Organisatie van Verloskundigen EMA Education Conference 29+30 November 2013 Maastricht an EMA-AVM-KNOV collaboration Profiling midwifery education by leadership & Science The essence of midwifery education, coaching student midwives in their practical training, curriculum development and assessments, bringing research and education together, educating midwifery leadership and last but not least about EU education-regulation and funding. Delegates 218 delegates from 20+ countries • 20 posters plus poster tour • 3 parallel sessions: 34 workshops EMA survey Key note speakers: Professor Cees van der Vleuten, Scientific Director School of Health Professions Education: Assessment Professor Soo Downe, Professor of Midwifery Studies. complexity and leadership Professor Raymond de Vries, Prof. medical school and department of sociology University of Michigan, Academie Verloskunde Maastricht/Zuyd University, School for Public Health and Primary Care: The value of academic skills in midwifery Mr. Konstantinos Tomaras, Deputy Head of the Unit "Free movement of professionals: What is up in the EU? Opinion on speakers: EMA social programme • The Welcome reception at the Maastricht City Hall • Conference dinner at “Museum aan het Vrijthof” Opinion on logistics Finances Investment KNOV & VA-M €10.000 each. Net RESULT € 14.398,14 (€7.200 each) Take home message! Next EMA conference? Where next? EMA Education Conference 2016 Patricia Gillen, Chair, RCM Board Suzanne Tyler, Director, Services to Members RCM Strategic Objectives 2014 • To promote high quality maternity services, professional standards and to lead the future of midwifery • To influence on behalf of our members and in the interest of the women and families for whom they care • To ensure products and services meet the particular needs of members • To support and represent our members individually and collectively in their respective countries • To ensure our future growth and sustainability as an innovative, adaptive and responsive organisation • To be an exemplary organisation and employer Education Conference Objectives • To challenge and disseminate current midwifery education knowledge and research • To provide a platform for discussion, networking and collaboration • To keep abreast with contemporary EU directives and education frameworks • To enable host country to address country specific issues gaining EU support Programme • 3 main themes – Regulation – Education – Midwifery practice • Call for abstracts – Concurrent sessions – Posters • Exhibitors – Masterclasses RCM Conferences Extensive experience of staging large-scale educational conferences and events in the UK. Expertise covers: • Sound financial management • Working with sponsors and partners • Managing media relations and publicity • Prominent speakers and ground-breaking content Conference venue Accommodation Visit London Midwifery in London Thank you Please put your name on the flip-board which workgroup you like to attend (2 sessions/person) Homebirth Developing midwifery practice standards Changing maternity policies IT tools for E-learning and professional communication Lunch Midwifery in Estonia Budget 2013-2014 Eva Matintupa Treasurer European Midwives Association EMA and social media Anita Prelec Board member European Midwives Association In beginning of 2014 Facebook https://www.facebook.com/europeanmidwives Twitter @Emidwives Website www.europeanmidwives.com www.europeanmidwives.net Most reached news • • • • • • Evidence of water birth 690 Vitamin D and nursing mother 872 Labour ward „not for regular birth“ 1252 Cosleeping and Biological Imperatives 3646 PLEASE, SEND INPUTS about National and international conferences and events, link to video, interviews, information Twin2twin EU Project proposal Franka Cadee Koninklijke Nederlandse Organisatie van Verloskundigen TWINNING in EUROPE East <> West North<>South • • • • • • • Method twin2twin Phase one: placing the persons midwifery in the context. formulate joint organizational goals assess joint capacity create a project structure foster relationships based on equality pairing of twins create joint communication channels Phase two: work on joint projects to gain experience in roject planning etc. • • • • create joint stories set evaluation moments create joint products celebrate together Projected impact of project • A better understanding among beneficiaries of a variety of midwifery issues within the EU • Empowered midwives who can become change agents in their own countries • Improved cultural understanding • Small ‘pilot’ projects will have been developed and tested. These can be scaled up. • Incited change in education, registration procedures, organization of professional body Cont. • Virtual learning platform to promote and support twin2twin (including forum, blog, etc) • Network of twins • Physical exchanges, long-lasting relationships beyond individual level • A sustainable platform of midwives that will be connected after the end of the project Participants per country: • midwifery education, • the professional association, • registration body? Countries interested • The Independent Midwives Association (AMI) of Romania, • Ecole de sages-femmes de Bordeaux, • Alliance of Bulgarian Midwives, • CYNMA (Cyprus), • Lithuania Midwives Association, • Estonian Midwives Association, • KNOV, The Netherlands, Way forward? Election of the Treasurer, Secretary and Vice-President Presentations and confirmation of venue GM 2015 Alliance of Bulgarian Midwives (ABM) is a voluntary, independent, non-political and non-partisan organization whose main goal is to work towards introducing the midwifery model of care. It is an association of midwives. Midwifery education in Bulgaria is provided by Medical Colleges affiliated with Medical Universities in Bachelor - level programmes. Midwifery education in Bulgaria is still subordinated to the medical model of care for pregnant women. The emphasis on prevantiv medicine and consulting skills is missing. The Alliance supports respecting women’s rights in childbirth ! Our annual meeting and training in European standards for midwifery model of care ! Our hope - midwifery model of care in Bulgaria and in all over the WORLD. An invitation to Bucharest, Romania Independent Midwives Association TALLINN, SEPTEMBER 2014 MELANIA TUDOSE ADINA PAUN INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA WHY BUCHAREST? INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA Le Petit Paris INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA The European Midwives Association Assembly of 2014 INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA The statistics Romania has: • the highest rate of infant mortality: 9,8 per thousand • the highest neonatal mortality : 5,5 per thousand • highest rate of under 20-mother mortality: 10,6 per thousand • second place in terms of maternal mortality: 21 per 100,000 • third place in percentage of cesarean sections in the total number of births: 36,9% • lowest rate of exclusive breastfeeding in the first 6 months of life : 12,6% in 2012. • in some areas, up to 25% women do not receive any healthcare until the moment they are in labor Source: European Perinatal Health Report 2010 INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA Romania’s midwives • Almost in-name only • No real implementation norms for the midwifery profession • International curriculum university programs with no real hands on experience • No jobs, no independent practice, no protection • More than 800 licensed midwives, out of which approximately 300 work as such INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA The Independent Midwives Association • In contact with all relevant authorities • Partnerships with women’s organizations • Working towards partnerships with embassies of midwifery friendly countries • Recently petitioned the European Commission to take up our cause INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA Thank you and see you in Bucharest! INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA All pictures credit of Mr. Vlad Parfenie, with our many thanks INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA Melania Tudose, president AMI +40 0722 751 540 / [email protected] Irina Popescu, vicepresident AMI +40 0722 658 054 / [email protected] Adina Păun, vicepreşedinte AMI +40 0722 272 270/ [email protected] Anca Belu, secretary AMI +40 0758 983 061/ [email protected] INDEPENDENT MIDWIVES ASSOCIATION, ROMANIA Candidates for venue GM 2016 Matters arising from Member Associations Closure of meeting General Meeting 2014 Tallinn Welcome! Opening Matters arising from yesterday Website for expecting mothers, managed by the Estonian Midwives Association Maret Voites, Board member Estonian Midwives Association Website for expecting mothers and families with children Maret Voites Estonian Midwives Association Perekool.ee www.perekool.ee is created by Estonian Midwives Association in 1999 The goal is to provide access to quality health information and trustworthy advice in the internet environment Team Manager Editor/administrator Project manager/administrator IT-specialist 5-8 voluntary forum moderators ~10-15 specialists for “Ask advice” section No office, everybody work from home Target group Expecting mothers or families with young children ~ 50 000 registered users 80 000 - 100 000 unique visits per week Statistics Webpage sections Articles “Ask advice” Videos FAQ Pregnancy calendar Marketplace Forum Database Articles ~50 % are original articles by specialists Pregnancy Schoolchild Birth Fathers Postpartum time Work, money, law Breastfeeding Health Baby and toddler Pregnancy calendar Videos We started publishing and producing videos in 2012 By now we have 55 educational videos in 5 categories: Pregnancy Birth Baby and toddler Breastfeeding Other 2014 project – Baby Diary “Ask Advice” Since 1999 2013 – 1555 questions-answers + 249 replies to forum 2014 target - 1800 questions Funding 2001-2011 Estonian Health Incurance Fund 2012-2014 Social Ministry projects “Ask Advice” Most questions about: Baby’s health, baby care and feeding Pregnancy Health incurance, financial support and legal issues 14 specialists: 6 midwives 2 paediatritians 1 gynaecologist 3 breastfeeding counsellors 1 speech therapist, child psychologist 1 lawyer Co-operation with other associations (family therapy, breastfeeding counsellors, lawyers etc) Frequently Asked Questions 336 questions and answers FAQ and answers throughout the years from “Ask Advice” Constantly updating the database Forum Most popular part of Perekool.ee Appr. 3000 new posts daily Most popular sections: Leisure time Baby Toddler Pregnancy Marketplace and advertisement Marketplace – for private and commercial users Advertisement spaces in Perekool.ee – banners, active textlinks, etc. Advertisement contract with Adnet Media Profit will be used for members additional education and training Value for midwives Patient education tools Reliable source of information Surveys and research (target group!) Income from advertisement THANK YOU! EU level session Mervi Jokinen President European Midwives Association Global policy and practice environment ‘The First’ - Lancet series on Midwifery 23rd June 2014 A set of papers http://www.thelancet.com/series/midwifery Global policy and practice environment • Improvement of maternal and newborn health through midwifery • The projected effect of scaling up midwifery • Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality • Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care Figure 1 Diagram of the multimethod approach used in this study Figure 2 The framework for quality maternal and newborn care: maternal and newborn health components of a health system needed by childbearing women and newborn infants *Examples of education, information, and health promotion include maternal nutrition, family planning, and breastfeeding promotion. †Examples of assessment, screening, and care planning include planning for transfer to other services as needed, screening for sexually transmitted diseases, diabetes, HIV, pre-eclampsia, mental health problems, and assessment of labour progress. ‡Examples of promoting normal processes and preventing complications include prevention of mother-to-child transmission of HIV, encouraging mobility in labour, clinical, emotional, and psychosocial care during uncomplicated labour and birth, immediate care of the newborn baby, skin-to-skin contact, and support for breastfeeding. §Examples of first-line management of complications include treatment of infections in pregnancy, anti-D administration in pregnancy for rhesus-negative women, external cephalic version for breech presentation, and basic and emergency obstetric and newborn baby care (WHO 2009 monitoring emergency care), such as management of pre-eclampsia, post-partum iron deficiency anaemia, and post-partum haemorrhage. ¶Examples of management of serious complications include elective and emergency caesarean section, blood transfusion, care for women with multiple births and medical complications such as HIV and diabetes, and services for preterm, small for gestational age, and sick neonates. Open Discussion re any EMA action points and strategies activities Coffee break Midwifery in Estonia Homebirths in four Nordic countries Preliminary results from the Nordic Homebirth Study Ellen Blix, Norway Homebirths in four Nordic countries (dk, is, no, se) Preliminary results from the Nordic Homebirth Study Ellen Blix, DrPH, MPH, RNM Professor in Maternal and Reproductive Health Faculty of Health Sciences The research field • Researchers may have very strong opinions about home births – which again may bias results • Important exception: The England Birthplace study 2011 Homebirths in four Nordic countries Lindgren H, Kjærgaard H, Olafsdóttir ÓA, Blix E. Praxis and guidelines for planned home births in the Nordic countries – an overwiew. Sex Reprod Healthc 2014;5:3-8 • 20.5 mill inhabitants • 220 000 births annually • Midwives attend all births • Welfare states • Similar historic and cultural background • Similar socio-economic background • But there are differences… Denmark • ~60 000 births • 7-800 planned home births (12/1000) • Homebirths attended by centre midwives and independent midwives • Some regions/hospitals provide homebirths with midwives who are specially affiliated the homebirth service • Midwives can prescribe necessary medicaments Denmark • The woman has the right to be attended by a midwife at home – also when home birth is not recommended • National guidelines support choice of birthplace • Home births a part of midwifery training • Home births are free of charge (except if the woman chooses a private midwife) • No midwifery-led units, 22 obstetric units • CS rate 22.1% Iceland • • • • • • • ~ 4900 births ~ 90 planned homebirths (18/1000) Homebirths attended by independent midwives Nearly all midwifery students attend one homebirth National guidelines support choice of birthplace Home births are funded by the health authorities The woman must find a midwife willing to attend homebirth Iceland • Iceland‘s association of midwives provides equipment and medicaments for homebirths • Decentralized care • Midwifery led units in smaller hospitals and health centres and at the University hospital in Reykjavik, 3 obstetric units • CS rate 14.8 % (lowest in Europe) Norway ~60 000 births 90-100 planned home births (1.7/1000) Homebirths attended by independent midwives Usually not a part of midwifery training National guidelines for homebirths support choice of birthplace • Home births are partly funded by the authorities • The woman must find a midwife willing to attend homebirth • • • • • Norway • Midwives do not have the right to prescribe medicaments • Decentralized and differentiated care • 49 birth institutions, including 10 freestanding midwifery-led units • 5 alongside units in big hospitals • ~8% of all births in midwifery-led units • CS rate 16.8% Sweden 106 000 births ~60-70 planned home births (0.6/1000) Homebirths attended by independent midwives Not a part of midwifery training No national guidelines on homebirths Homebirths are funded only in the county of Stockholm and under certain premises • The woman has to pay herself (except in Stockholm) • The woman must find a midwife willing to attend homebirth • • • • • • Sweden • Midwives do not have the right to prescribe medicaments • One alongside midwifery-led unit, obstetric units • CS rate 17.1% Developing midwifery practice standards Ute Wronn, Germany Miriam Wille, Swiss A story of success: Midwives define the quality of midwifery care – First National Midwifery Expert Standard for the Promotion of Normal Birth European Midwives Association Annual Grand Meeting, Tallinn, Estonia 26th /27th September 2014 Ute Wronn International Delegate German Association of Midwives (DHV) Overview First National Midwifery Expert Standard for the Promotion of Normal Birth • • • • • • Background What‘s so special Definition and core functions Structure Methodology Prerequisites EMA AGM 2014 Tallinn Ute Wronn DHV 146 National Midwifery Expert Standard on the Promotion of Normal Birth University of Applied Sciences Osnabrueck • German Network for Quality Development in Nursing, DNQP head: Prof. Andreas Buescher • Network of Midwifery Research head: Prof. Friederike zu SaynWittgenstein Information in English: http://www.dnqp.de/38413.html http://www.hebammenforschung.de/ne tworkmidwiferyresearch.html EMA AGM 2014 Tallinn Ute Wronn DHV 147 How it all started • team of midwifery researchers committed to work on practice-relevant midwifery issues • research project: „Midwifery Care during pregnancy, childbirth and postpartum period – tools to develop crosssectoral quality“ (IsQua) • concerns – rising C-section rates – rising intervention rates – staff shortages in clinical settings working conditions and procedures impact on childbirth • need for scientific evidence on midwifery practice research proposal (by midwifery research network) EMA AGM 2014 Tallinn Ute Wronn DHV 148 Why is this Expert Standard so special? • first midwifery standard in the history of German midwifery • developed by midwives (researchers and clinical midwives) for midwives (supported by experienced nursing researchers, DNQP) • aim: offer every childbearing woman the midwifery support she needs and requires for a normal birth • does not exclude women who are going to have a C-section (e. g. on demand); counseling and guidance is open to pregnant women during scheduled midwifery consultation EMA AGM 2014 Tallinn Ute Wronn DHV 149 Definition (credit: DNQP) Expert standards (nursing) • reflect a determined level of professional performance matching the needs of a target population and imply evaluation criteria • provide guidance and alternatives for professional action and decision-making • are suited for nursing/midwifery care problems requiring a considerable level of attention and assessment and are characterized by a highly interactive nature • are not: guidelines or clinical decision rules EMA AGM 2014 Tallinn Ute Wronn DHV 150 Core functions and purpose of Expert Standards (credit: DNQP) Core functions • define professional accountability • initiate innovative thinking • promote evidence-based practice and professional identity • initiate a constructive interdisciplinary dialogue on quality of care/midwifery care Purpose • bridge theory and practice • impact on professional responsibility • serve as quality assurance tools • serve as expert evidence accepted by legal judgement EMA AGM 2014 Tallinn Ute Wronn DHV 151 Structure of an Expert Standard (credit: DNQP) Scope and purpose: aim of the standard, target population Structure: ressources, organisational structure Process: what is actually done Outcome: planned results • • • • The midwife: • assesses • plans • carries out • evaluates The client is… The client can… The client says, that… The client seems to… There is … Environment Infrastructure Personal ressources Equipment „National Midwifery Expert Standard for the Promotion of Normal Birth“ S1a: The hospital has regular midwifery consultation times for pregnant women in order to plan and advise. The hospital provides adequate rooms, staff and euipment for midwifery consultation. S1b: The midwife is competent to counsel pregnant women with regards to normal birth. P1 : The midwife enquires the woman‘s expectations, needs, concerns and fears. The midwife provides the woman with comprehensive counseling and information. She/he offers ways to identify expectations and how to best obtain assistance within the delivery unit on ways how to realize expectations and to have support in the delivery unit. EMA AGM 2014 Tallinn Ute Wronn DHV E1 The woman is fully informed about the support of normal birth. There is an adequate documentation about the counselling and planning An appropriate documentation on the counselling and planning process in place. 152 Methodological approach (following RCN, UK) (credit: DNQP) topic selection (by midwifery expert group) convening an independent panel of experts (researchers, practicing professionels, civil society,…) literature review (findings commented by expert group, „evidence meets experience“) development of an evidence-based standard consensus conference implementation in model projects (training, adaptation to specific needs): several stages public presentation, monitoring and update final version, introduction of national standard EMA AGM 2014 Tallinn Ute Wronn DHV 153 Prerequisites for the development of professional guidelines, standards and tools • strong will to develop an autonomous profession: Midwives define quality of midwifery care! • strong will to define explicit and transparent criteria for professional midwifery practice • strong commitment to midwifery research • close cooperation between midwifery association/chamber/stakeholders and midwifery researchers • engagement in complex debates about needs, requirements and quality of midwifery care (intra- and interprofessional level) EMA AGM 2014 Tallinn Ute Wronn DHV 154 National Midwifery Expert Standard for the Promotion of Normal Birth Who else but midwives can define the contents of midwifery?... Thank you for your kind attention Thanks to DNQP for support and sharing conference slides! • www.hebammenforschung.de/networkmidwiferyresearch.html • www.dnqp.de/38413.html Ute Wronn International Delegate DHV German Association of Midwives www.hebammenverband.de [email protected] EMA AGM 2014 Tallinn Ute Wronn DHV 155 Interdisciplinary Ceasarean Section Brochure Miriam Wille Swiss Federation of Midwives, SHV 1. 2. 3. 4. 5. 6. 7. How it all began How the brochure came into being The interdisciplinary working group Difficulties in the process The final product Purpose of the brochure Publication and distribution Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 157 1. How it all began The Cesarean section rate in Switzerland is continuously rising 1998= 22.7%- 2007 = 32.2% Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 158 Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 159 This rising trend arouses no immediate interest neither from the media, nor health insurance companies, nor medical stakeholders nor the government. Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 160 2. How the brochure came into being • Actions initiated by the Swiss Federation of Midwives (SHV) • Position paper including catalogue of measures is adopted • Parliamentary intervention is submitted to the plenary • Scoop press release was issued • Letter sent to Santésuisse to safeguard the WZW- Law • Cooperation with expert associations is aimed at Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 161 • Parliamentary intervention Motion by Liliane Maury Pasquier (18 December 2008),Member of the National Council and President of the Swiss Federation of Midwives 2009-2013 Submitted text The Federal Council is required to examine the reasons for and consequences of the high cesarean section rate in Switzerland as well as identify possibilities how to counteract the negative effects on mother and child and on the health care system. Grounds The Swiss Federal Law on Health Insurance (KVG) obliges the Federal Council to examine the economic efficiency, expediency and effectiveness of medical interventions. Several factors indicate that in the sector of obstetrics, medical interventions that do not comply with these criteria are carried out and financed by mandatory health insurance. Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 162 • How the SHV looked for interdisciplinary cooperation and found it There is a demand for extensive information on the advantages and disadvantages of the ceasarean section among pregnant women. The Swiss societies for neonatology, gynecology, pediatrics and midwives are committed to develop an interdisciplinary patient information brochure to enable an informed choice for a ceasarean section. Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 163 3. Work within the interdisciplinary group • Phase 1 • Project design and drafting of the text, April 2011- May 2012 • Funding secured, by the foundation; Health Promotion Switzerland • Set target: publication in 2012 Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 164 • Phase 2 • Draft review by specialist associations, May 2012 November 2012 • The Society of Anesthesiologists joins the working Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, April 2014 165 4. Difficulties in the course of the drafting process Search for consensus between expert associations blocks the process November 2012- September 2013: • Difficult phase, as an agreement on contents cannot be reached • Personnel changes within the working group • Absence due to illness results in delays • Various media reports lead to a debate on principles about the purpose of the brochure among gynecologists September 2013: • The association for gynecology pulls out of the project Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, April 2014 166 Federal Council finally reacts to political initiative • The high rate of Cesarean sections in Switzerland cannot be explained with simple cause-effect relationships • A review and update of established guidelines for supporting decision making processes is proposed • Hence, the Federal Council in its reply supports the joint purpose of the expert societies to compile a brochure on Cesarean sections Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, April 2014 167 September 2013 – February 2014: In spite of the pullout of the society for gynecology the other expert associations continue the project The brochure is completed, edited and translated into three national languages Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 168 5. The final product Content 1. Cesarean section: the facts 2. The process of a ceasarean section 3. How mother and child feel afterwards 4. Frequently asked questions concerning ceasarean sections 5. The publishers of this brochure Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 169 6. Purpose of the brochure Midwives, pediatricians, neonatologists and anesthesiologists collectively provide comprehensive information on the topic of Cesarean sections in this brochure In order for mothers to be/couples to make an informed decision, they need a thorough understanding of what happens during this procedure and what possible consequences need to be taken into consideration Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 170 • This brochure serves as a basis to then discuss the individual situation with a midwife and/or gynecologist and make an individual decision Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 171 7. Publication and promotion • Publication of the brochure at the end of March 2014 • Distribution within the expert associations to all members • Distribution to counseling centers and medical practices • Publication in professional journals • Brochures can be ordered from the expert societies Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 172 • Media relations work has happend • Core message: The topic of ceasarean sections is relevant. It is worth looking at it in detail! Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 173 Questions Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 174 Expert Associations • www.hebamme.ch • www.sgar-ssar.ch • www.neonet.ch • www.swiss-paediatrics.org Interdisciplinary Ceasarean Section Brochure, Swiss Federation of Midwives SHV, 2014 175 Changing maternity policies Maria Cutajar, Malta Permanthia Panani, Greece Changing Maternity Services MARIA CUTAJAR MALTA INTRODUCTION • During this presentation insight will be given to describe the process of improving maternity care through initiatives conducive to change in maternity services in Malta. MIDWIFERY IN MALTA One General Hospital – Obstetrics & Gynaecology Department cater for 98% of all births Midwifery input during Antenatal period * Antenatal Education Programme * Booking Visit * Care for hospitalised pregnant women. Intrapartum Care Postnatal Care Community Care Background • The Maltese maternity care is fragmented and is more medically oriented rather than women-centred. • As stated during the EMA AGM held in Malta in 2008, Antenatal care is mainly provided by the obstetricians, rates of induction of labour and caesarean sections are still high. • Reports on the factors that influence the service users and service providers, the organisation and the nation recommend widespread reform in the way services are organised, all heralding a state of massive change. Midwifery Initiatives • Such initiatives were also CATALYST for the introduction of new services: (Midwifery community care, Hospital based assisted reproductive technology clinic, Female Genital Mutilation Bill and awareness) improvement of other services (Normalising Childbirth, Breast feeding baby friendly initiative) This happened through collaboration between: service users, policy makers, midwives, paediatricians, obstetricians, other health care professionals and NGO’s. CHANGE was based on education, evidence and experiences adapted to the local needs: • Research findings and training needs analysis • CPD activities • Experience of professionals working both in a local and international setting (education supported by EU funds): • Normalising Childbirth & Breastfeeding Baby Friendly Mobility Project 2009 – 2011 (23 Midwives – 2 weeks experience in Midwifery Led Unit UK) • Normalising Childbirth Training Module (Malta – UK – Malta, 68 Midwives followed 92 hours programme – study week University of West England Bristol & visit to MLU). • Discharge Liason Midwives postnatal community services for 1 month in a Hospital in Ireland) (5 midwives This change: • Raised the profile and status of the midwifery profession. • Provided avenues to explore constraints and opportunities. • Understanding of the occupational and professional relationships necessary to face the challenges encountered. WHY CHANGE WAS NEEDED? • High rates of unnecessary intervention during pregnancy and childbirth • Fragmentation of care • Under utilisation of midwifery skills • Professional development of midwives • Unsatisfied service users • Lack of job satisfaction and demotivation due to difficulty in maintaining high quality maternity services • Shortage of hospital beds • Research findings • Midwives’ experiences abroad • Sustainable services – awareness of wastage of resources • Successful experiences How this Happened? • Change was possible through CONSULTATION AND COLLABORATIVE APPROACH from all stake holders. • Change is happening gradually consistent, though still long way to go but • Move from a Hospital-focused and Medical oriented model of care, to a women centred care approach. POLICY MAKERS Minister of Health Minister of Social Policy Parlamentary Secretary / Health Shadow Minister for Health MEPs Hospital Management BE THE VOICE NGO’s, Unions & Organisations Media Expectant & New Parents & General Public CONSULTATION DOCUMENTS POSITION STATEMENT Strategic Direction for Strengthening Midwifery in Malta 2011 Breastfeeding Policy 2014 National Health Strategy 2014 – 2020 Become a Regulated Practice offered in Public Health System implantation of two fertilised ovum POSITION STATEMENT IVF BE THE VOICE FGM Seminars / Conference on Topic Increase Awareness Improve Service RESOLUTIONS NCW Normalising Childbirth Breastfeeding FGM Perinatal Mental Health Sexual Assault Clinic OBSTACLES/ BARRIERS: • Process was not easy and there where barriers which could have hindered the process to improve midwifery care. Some of the problems were: •Interdisciplinary/professional Conflicts •Political professional power •Organisational Culture (Highly medical oriented model of care) •Increasing shortfalls in numbers of midwives •Limited budget/funds •Limitations of regulation and standards and their comparability at a national level •Lack of resources •Resistance to change Through collaboration: •Set up a focus group at Ministry level •Analyse the service delivery, models of care and organisation of services •Formulation of midwifery guidelines •Practice skills that promote normality (more doctors are cooperating and slowly coming on board) •Improve recognition of the midwife (limited role during the antenatal period) •Set up a strategic direction and a way forward •Set up a strategy for future education of midwives (as regards specialisation areas and continuation of further education) •Get all concerned on board – to minimise resistance to change •Put forward recommendations for policy and the regulation of midwives •Improve communication across sectors •Promote organisational links and cohesive leadership •Improve inter-sectoral collaboration in the long-term •Strengthen Midwife / mother relationship Conclusion: This 'rethink' of the systems and organisation of health care delivery in Malta needs to: • address priorities for care and safety • meet the needs of consumers • be guided by evidence and demonstrate cost effectiveness • be mindful of the need to maintain and develop a skilled health workforce Put simply, these developments should occur within a framework of three basic principles: choice, control and continuity. CHANGING MATERNITY SERVICES IN GREECE PERMANTHIA PANANI President of Hellenic Midwives Association EMA Annual Meeting, Tallin, Esthonia 2014 • The midwifery role in primary health care is autonomous, discrete and necessary. THE ROLE OF THE MIDWIFE IN PRIMARY HEALTH CARE *(PRIORITY FOR HELLENIC MIDWIVES ASSOCIATION) • Within her competences, a midwife, takes action and interferes supportively, aiming women’s and their families health. • The care that a midwife provides to the community is holistic and of proven effectiveness to the quality improvement of health services provided to a woman and her family. Women must have access to a supportive and high quality network of health services which has to be developed for their individual needs and the needs of their families. Our vision is: 1.VISION Healthy families Individualized care, according to their own needs Normal pregnancy and natural birth Care that will will have a positive impact on good clinical and psychological results for the woman and her child. The framework of the midwifery activities in the Primary Health Care unit is based in four priority axes: 2. ORGANIZATION OF MIDWIFERY ACTIVITIES FRAMEWORK IN THE COMMUNITY • Prevention (gynaecological cancer screening, prevention of Sexually Transmitted Diseases) • Provision of midwifery care at home (antenatal/ postnatal care, breastfeeding promotion) • Health Education (Family planning, educational presentations at schools, preparation and education for transition to parenthood) • Protection and promotion (protection of safe motherhood, promotion of natural birth) 1) 3.PROPOSALS FOR THE MINIMUM SET OF SERVICES OF A MIDWIFE IN THE COMMUNITY Promoting physical and mental health of the mother, the infant and the family as a unit of the society 2) Holistic perinatal care in the community (pregnancy, childbirth, postpartum) with a vision to promote safe motherhood and meeting the specific needs of the family. 3) Implementation of international protocols and guidelines for monitoring / evaluation of pregnancy, childbirth and postpartum and improving the quality of network services and health indicators of perinatal morbidity and mortality, reducing the Caesarean Section rates, increasing breastfeeding rates etc. 4) Prenatal screening and early identification of deviations from the normal physical and mental progress and direct reference, if necessary. 3.PROPOSALS FOR THE MINIMUM SET OF SERVICES OF A MIDWIFE IN THE COMMUNITY 5) Preparation for parenthood, promotion of natural childbirth and encourage scientifically acceptable methods for neonatal care and breastfeeding, promotion of the development of a healthy parent-infant relationship. 6) Prescription (diagnostic tests, drugs) during pregnancy, childbirth and the puerperium 7) Home visits by the Community midwife during the perinatal period (pregnancy, childbirth, postpartum) 3.PROPOSALS FOR THE MINIMUM SET OF SERVICES OF A MIDWIFE IN THE COMMUNITY 8) Breastfeeding Counselling (support, promotion, protection of breastfeeding) at individual -group level and community level 9) Promotion of women's health in all life periods (adolescence, reproductive age, menopause) 10) Screening tests (test-pap, mastography, etc.) 11) Prevention of Sexual Transmitted Diseases, vaginal fluid culture 12) Health Education in schools and community agencies 13) Recordkeeping / Research in Women's Health 1) Improvement of the quality in midwifery care services 2) Strengthening midwifery practice in our country 3) Organization of seminars 4) Evaluation of midwifery practice every 3 4.ACTIONS years 5) Communication & collaboration with women’s organizations. Their power forces the Ministry of Health to accept our proposals and make all the necessary changes. 6) Our collaborations are the result of the advertisement of our work in the media. 4.ACTIONS The first action from the Ministry of Health have already started: In collaboration with Hellenic Midwives Association, three programmes have been designed to be initiated in 2015: • Family Planning • Care of mother and baby • Community Midwifery ANY Any questions Lunch Midwifery in Estonia Workgroups Homebirth (M. Carroll, Ireland-Ellen Blix, Norway, Mervi Jokinen, UK) Developing midwifery practice standards (Ute Wronn, Germany- Miriam Wille, Swiss, Eva Matintupa, Finland) Changing maternity policies (Maria Cutajar, Malta-Permanthia Panani, Greece, Agnes Simon, France) IT tools for E-learning and professional communication (Marge Mahla, Estonia, Joeri Vermeulen, Belgium, Anita Prelec, Slovenia) Coffee break Midwifery in Estonia Feedback from the workgroups Release of press statement Summary and identification of overall actions 2014-2015 Summary of meeting Thanks and closure of the meeting